Pathological Demand Avoidance, or PDA as it is widely known, was defined as a neurological condition in the 1980s.
It is not easy to know statistics about the numbers of people with PDA, because there is not a regulated route that is used to evaluate the condition. The PDA Society suggests that approximately one in five autistic adults had “indications of having PDA in childhood,” inferring that 20% of our autistic population may have a PDA profile.
As far as we know, PDA is linked to some members of the autistic community. Although it has been suggested that PDA may be definable outside of autism, it is presently assumed by most professionals that only people with autism could additionally carry a PDA profile.
SEND tutor Kate Fuller, who has a MSc in Psychology states that, “Children are complex, with layers of unique traits like an onion; each layer is a factor to consider, such as genes, gender, personality, diagnoses, environment and circumstance. Where there are PDA traits, demand avoidance may be seen as the most obvious layer. However, many children without PDA will also avoid certain demands, such as doing their homework or tidying their bedroom. The difference lies where children with PDA can’t comply with demands, even when they want to!”
Examining whether a child has PDA is not a cut and dried formula. In addition, as Kate says, there are so many layers to consider.
What Are The Signs Of A PDA Nature?
When assessing whether your child has PDA, it can be useful to look at the following indicators:
- Demands & Avoidance
- Anxiety & Dysregulation
- Autonomy
- Impulsivity
- Role Play
With ”demand” and “avoidance” in the title, we have learnt that a PDA-er (as they are often called), has a systemic need to avoid demands. That is not to say that you can never present a PDA child with a demand. Every child, in every moment has a complex web of reasons as to why they may not be able to comply.
As a parent observes their child, they will spot their unique PDA traits, and how they impact on their world.
Demands for a child with PDA can be overwhelming. For some, it triggers anxiety and rising panic. Their unique neurological programming does not allow them to comply with the demand.
When a child with PDA experiences anxiety, they are unlikely to have control over their response. As such, a period of dysregulation can ensue, leaving them unable to contain their emotions, which can sometimes cause outbursts, withdrawal or meltdowns.
When demands and questions are removed, a PDA-er may gain a greater feeling of autonomy, which is the foundation of their existence. To lose that mechanism may feel like the floor is snatched away, triggering a fight or flight response which can spark a collapse in behaviour.
As a child with PDA seeks to avoid demands and maintain control of their world, they may at times portray impulsive behaviour in addition to sudden mood swings.
Role play can provide security for a PDA child as they can freely explore what it is like to be someone else. It offers a creative outlet, away from their symptoms, serving as a helpful tool towards processing their feelings, and understanding empathy and relationships. The experience of role play also gives them the desired feeling of control.
Does My Child Present A Mild, Moderate or Extreme PDA Profile?
We have presented possible indicators of the condition, but how might we decide to what degree a child has this presentation?
As mentioned previously, children with a Special Educational Need or Disability (SEND) are unique and will present differently. Families will gradually discover their child’s traits and how best to support them.
Kate points out that one way of identifying PDA is when a child is unable to do something someone else asks them to do, even when they really want to do it!
She illustrates the point: “A PDA-er may want to go bowling and really enjoy the activity. A family trip to the bowling alley is planned, and the wrong phraseology is directed at the child just before leaving, such as ‘put your shoes on’ or ‘we are going to be late’. The child may then feel intense anxiety by being faced with a demand, and be unable to comply or take part.”
Kate continues with an example from “Avoiding Anxiety in Autistic Adults,“ written by Dr Luke Beardon. In the book, Dr Beardon shares an example of a man with PDA who returned from an outdoor run, very hot, perspiring and looking forward to a long hot shower. However, when his wife inadvertently told him to ‘go and have a shower’, he found himself unable to do so.
The demand and his rising anxiety resulted in him not being able to take the shower he desperately wanted just moments before.
It might be beneficial to consider the above-mentioned areas, and then ask: What does my child do that suggests PDA? How do PDA traits manifest themselves in my child?
Possibly, the most significant question might be: “How can I appreciate my child’s PDA traits and inform the people that interact with him or her how to nurture these traits in a way that is relatable for my child?”
The definition of autism has frequently been linked to a spectrum, but is more recently defined as a spiky profile, unique to each individual. Is it possible then that rather than assuming PDA is always found in autistic individuals, it could be more helpful to look at PDA within its own entity?
PDA-ers may be on a spectrum, but their presentation may mean that the way we support them should be different.
Kate illustrates this point clearly, “We know that an autistic child will respond well to routines, clear timetables and boundaries being put in place at school. However, PDA-ers may not be able to cope with such strict structures, lack of flexibility and perceived lack of control. Rather, the use of choice, options and allowing some control can give them the autonomy they need. This is in direct conflict with how we would normally support an autistic individual in a school-based setting.”
Therefore, even though a child with PDA is also autistic, it is not always useful to use autistic-friendly structures with PDA-ers.
I Think My Child Has PDA. What Shall I Do?
If you notice that your child has PDA traits, it may be a good point to reach out for help.
The PDA Society offers specialist advice and support, aiming to help families understand PDA more fully, whilst offering support and guidance.
By reaching out to people that will grasp your child’s neurological pattern of behaviour, you will learn how their PDA traits impact on their routine. You can then gather ideas about how to help them with their version of the condition.
Kate explains, “As you spend time with a child with PDA, it will become more apparent how their mind works, and how their PDA traits impact on them. From there you can work towards the best approach.”
As you learn about PDA, useful strategies will become apparent. Kate cites one multitasking strategy that can be helpful. “Some PDA-ers cope better with demands when multitasking, finding that their anxiety is more easily managed when they are partially distracted.
“One of my PDA pupils is unable to attend school if her anxiety is high, meaning she needs to catch up. We have found it effective to run parallel projects. For example, she was completing a project on science, involving minibeasts and their habitats, whilst also working on a non-fiction book around her special interest. The student could then move between projects to maintain engagement, should anxiety in one area become overwhelming.”
On another occasion, the school had asked that the student catch up on the standard written method for multiplication due to missing a class. Kate needed to find a way to include this in the lesson, without the child becoming anxious, given that it was a discrete learning task.
Kate continues, explaining how she resolved the situation: “I used the student’s special interest in her pet rodents to make word problems requiring multiplication using MagicSchool AI. The characters in the problems were based on her pets and allowed her to put aside her anxiety around the calculations because she wanted her pets to be successful in the problems.”
By combining the student’s special interests into the multiplication problems, Kate used multitasking techniques to execute the lesson successfully for her PDA-er.
Kate has many strategies that she uses with children that present with PDA. Whatever your child’s PDA traits, you will gradually find that there will be ways to support them to ensure the smoothest possible learning journey.